Atherosclerosis is a chronic inflammatory disease of the arteries, characterized by the formation of characteristic changes in their walls – atherosclerotic plaques. Atherosclerosis may be asymptomatic or cause, inter alia, coronary pains (as well as myocardial infarction), intermittent claudication and neurological symptoms. Atherosclerosis, which develops insidiously over many years, is the cause of cardiovascular diseases (e.g. heart attack). In the prevention of atherosclerosis, the most important thing is a proper lifestyle – maintaining a proper diet, correct body weight, physical activity, not smoking.

What is atherosclerosis?

Atherosclerosis is a disease of the arteries leading to a narrowing of their lumen. The cause of the stenosis is theatherosclerotic plaque(Figure 1B), mainly made of cholesterol, that grows out of the artery wall, reducing blood flow (ischemia), resulting in organ hypoxia.

How common is atherosclerosis?

Atherosclerosis can begin very early in life, even in childhood, but usually it does not develop symptoms until the age of 50-60. Atherosclerotic lesions of varying degrees of severity occur in different arteries in the same person, and even in the same artery. The speed of their development is variable and tends to accelerate periodically. The earliest changes that already occur in children are the so-called asymptomatic fatty infiltration, which may regress or intensify and lead to the formation of atherosclerotic plaques.

Significant changes in the epidemiology of atherosclerosis have been observed in recent years. In the past, atherosclerosis occurred mainly in older men, now in women, younger people and in the very elderly,heart attackscaused by atherosclerosis of the coronary vessels are more and more frequent. There is also a significant increase in the number of people with atherosclerosis in countries with a low and medium level of economic development.

Atherosclerosis – symptoms

Atherosclerosis occurs in the arteries that supply blood to all organs and parts of the body. For this reason, symptoms of atherosclerosis can vary depending on where the blood supply is most impaired.

Atherosclerosis – coronary pain

If the atherosclerosis affects one of the coronary arteries that supply blood to the heart muscle, we are talking aboutcoronary artery disease. Atherosclerotic plaques lead to a narrowing and even closure of the coronary arteries as manifested by coronary pain, which usually occurs with exertion and quickly resolves after exercise has ceased. Typical coronarypain is chest pain– felt behind the breastbone, it can radiate to the neck, lower jaw, left shoulder, left shoulder (and further usually along the ulnar nerve to the wrist and fingers) or to the upper abdomen. Pain is caused by physical exertion, emotional stress, and is relieved at rest – it usually lasts a few minutes. When the atherosclerotic plaque ruptures (Fig. 1C), a blood clot forms (Fig. 1D), which may result in myocardial necrosis, i.e. an infarction.

Dig. 1.A – normal vessel, B – atherosclerotic plaque growing out of the artery wall, C – ruptured atherosclerotic plaque, D – vessel completely closed by a thrombus

Atherosclerosis – intermittent claudication

Atherosclerosis, which develops in the artery that supplies blood to the lower limb, is characterized by pain in the muscles of the lower leg (calves) when walking or running. This symptom is called intermittent claudication. Pain occurs with fairly constant regularity after performing certain muscle work, that is, walking a certain distance. Pain (sometimes perceived as numbness, muscle stiffness) forces the patient to stop and disappears spontaneously after several dozen seconds or a few minutes of rest. Pain is more common when going uphill than when going down. Most often it is located in the calf muscles.

Atherosclerosis – narrowing of the carotid and vertebral arteries

Atherosclerosis can also affect the arteries that supply the brain with blood, i.e. the carotid and vertebral arteries. The course of stenosis of the carotid or vertebral artery may be asymptomatic or symptomatic. Symptomatic carotid stenosis means that you have experienced transient or persistent symptoms of cerebral ischemia in the last 6 months, such as:

1. motor or sensory disorders – paresis and paralysis, sensory disturbances
2. speech disorders if there is a narrowed artery on the side of the dominant hemisphere
3. visual disturbances on the side of stenosis

Symptomatic vertebral artery stenosis may be responsible for strokes or symptoms of the so-called vertebrobasilar failure, which sometimes include temporary: tinnitus, impaired hearing acuity, gait disturbances, sudden, paroxysmal and repeated laxity of the lower limbs,dizzinesswith a spinning sensation of the patient or objects around him, a second feeling of darkness or the sensation of waving viewed objects .

In more serious cases, it can even lead toa stroke.

Atherosclerosis can also causeaortic aneurysm.

The causes of atherosclerosis: how is plaque formed?

Atherosclerosis is characterized by the slow accumulation of substances such as cholesterol from the blood and cells called monocytes in the walls of arteries.

Monocytes, after transforming into macrophages, i.e. phlegm cells, absorb LDL lipoprotein particles (the so-called bad cholesterol) accumulating in the vascular wall and fill them up – macrophages filled with cholesterol are called foam cells.

Atherosclerotic plaque forms as a result of the accumulation of cholesterol in the artery wall.

Atherosclerotic plaques, rich in cholesterol and foam cells, rupture easily. If the rupture is large, a thrombus closes the artery and the area supplied by the diseased artery is suddenly ischemic, which can even lead to necrosis (seeHow plaque is formed).

Especially young atherosclerotic plaques, poorly overgrown with fibrous tissue, are prone to fracture, separating them from the circulating blood stream. Such plaques are not large and narrow the artery to a small extent. This means that the patient, despite the presence of atherosclerosis, may not have symptoms of the disease (e.g. in the form of coronary pains) and may experience a heart attack suddenly, in a seemingly healthy state.

Keep in mind that not every plaque rupture leads to a heart attack. A small rupture can cause a clot to develop in the center of the plaque, that is, in the wall of the artery, not in its lumen. This causes an enlargement of the atherosclerotic lesion. Over time, such an atherosclerotic plaque gradually becomes fibrotic and strengthens (a strong cover is formed that protects it from breaking). In this way (despite the low risk of rupture of the atherosclerotic plaque), as a result of severe narrowing of the lumen of the artery, and thus – impaired blood flow – the symptoms of ischemia described above often occur (Fig. 2). It is also worth knowing that in the artery wall there are atherosclerotic plaques of varying degrees of development, i.e. both young and advanced, i.e. easily rupturing and narrowing the lumen of the artery.
Dig. 2.A – atherosclerotic plaque with intrinsic bleeding, B – plaque with an focus of calcification, C – plaque critically narrowing the lumen of the artery

Who has atherosclerosis?

Atherosclerosis develops in virtually all people. The first atherosclerotic lesions may appear even in early childhood, but symptoms such as ischemic heart disease, intermittent claudication, ischemia or stroke usually affect people over 50 years of age.

The rate of development of atherosclerosis varies greatly from person to person. It depends on the presence and severity of risk factors.

Prevention and treatment of atherosclerosis

The sooner the prevention of atherosclerosis is started, the better. As mentioned earlier, the development of atherosclerosis begins in early childhood. The severity of changes at a young age, as in adults, depends on the presence and severity of risk factors.

Prevention of atherosclerosisis the prevention of cardiovascular diseases, which are the main cause of death in the majority of European populations and an important cause of disability. Developing insidiously over many years, atherosclerosis is a fundamental process underlying cardiovascular disease. A heart attack and stroke occur suddenly, and death may occur before medical attention arrives and effective treatment can be administered.

Major risk factors for cardiovascular disease can be modified. Belong to them:

1. incorrect nutrition
2. smoking tobacco
3. little physical activity
4. high blood pressure
5. increased concentration of LDL cholesterol in plasma
6. increased plasma triglyceride levels
7. decreased plasma HDL cholesterol levels
8. pre-diabetes or diabetes
9. overweight or obese.

Atherosclerosis – diet for children and adults

However, the diet of Poles still differs from the principles of healthy eating, which is also effective in the prevention of cardiovascular diseases. The consumption of vegetables and fruits is too little, too much red meat, especially processed meat, too much energy from fats, especially from saturated fatty acids and trans isomers of unsaturated fatty acids, too much sugar and fructose and salt consumption, and too little energy from carbohydrates derived from whole grains.

In 2018, as much as 30.9% of men and 20.2% of women smoked cigarettes, and 62.2% of men and 45.5% of women were overweight or obese (BMI ≥25 kg / m²).

The principles of healthy eating are universal, although they may vary slightly depending on the population and local eating habits and health problems.

Basic nutritional recommendations

1. Meals should be eaten regularly(every 3-4 hours, 4-5 meals a day).
2. Vegetables and fruitshould be consumed as often and in as large quantities as possible, ≥400 g / day. They are a source of a large amount of bioactive compounds (carotenoids, vitamins C and E,folic acid, selenium, flavonoids, isoflavones), potassium and fiber.
3. Cereal productsare an important part of the diet . Choose whole grains (wholemeal) that provide B vitamins, minerals (magnesium, zinc) and dietary fiber. The carbohydrates contained in them are a source of energy.
4. For the prevention of cardiovascular diseases,lean dairy productsare recommended . Skim milk or yogurt is preferred. In a limited amount, low-fat milk, yoghurt, cheese are allowed. Milk and milk products are a rich source of calcium, wholesome protein as well as vitamins B2, B12 and magnesium.
5. The consumption of meat, especially red meat and processed meat products,should be limitedto 0.5 kg / week. It is recommended to eat fish, legumes and eggs (1 egg a day does not increase the concentration of LDL cholesterol in the plasma). Fish (fatty) is a source of ω-3 unsaturated fatty acids. Legume seeds provide valuable protein, fiber and vitamins B1, B6 and PP.
6. You shouldlimit the consumption of animal fats(saturated fatty acids) and replace them with non-tropical vegetable oils (unsaturated fatty acids). Replacing saturated fatty acids with unsaturated reduces the risk of cardiovascular disease. It is recommended to avoid harmful trans isomers of unsaturated fatty acids. There are, among others in fast food and ready-made confectionery products (wafers, cookies, bars).
7. The consumption of sugar and sweets should be limitedas they contribute to the development of overweight and obesity and, consequently, to type 2 diabetes and elevated plasma triglycerides. In addition, sugar contributes to the development of tooth decay. It is recommended to replace sugar and sweets with fruit and nuts.
8. You should not add extra salt to your food, and when shopping, it is worth choosing food products with a low salt content. The taste of the dishes will be enhanced by herbs and they will also provide valuable ingredients. Salt contributes to the developmentof hypertension.
9. Rememberto drink water≥ 1.5 liters per day.
10. It is recommended not toconsume alcohol. It contributes not only to the occurrence of pancreatitis andcirrhosis of the liver, but also tocancersof the gastrointestinal tract, breast and prostate gland. Alcohol also causes arterial hypertension, hypertriglyceridemia and cancers of the oral cavity, pharynx, larynx, esophagus, liver, colon, rectum.

As part of the prevention of cardiovascular diseases, healthy people are recommended to undertake physical activity – ≥150 minutes / week. aerobic (aerobic) exercise of moderate intensity or 75 minutes / week. high-intensity aerobic exercise, or an equivalent combination of these. For additional benefits, it is recommended that you gradually increase your moderate-intensity aerobic exercise up to 300 minutes / week, and high-intensity aerobic exercise up to 150 minutes / week. Training sessions should be spread over several (ie 4-5) days a week, preferably every day.

Is it possible to reverse atherosclerosis?

Knowledge about atherosclerosis is constantly changing, new research is emerging and current views are being verified. Currently, it is believed that atherosclerosis develops irregularly, its development is not continuous, it may resolve, and lifestyle and medications may modulate its course.